PSEO State Form Tips - University of Northwestern

PSEO State Form Tips
Once completed, you can scan/e-mail to us at [email protected] or fax to 651-631-5680.
POSTSECONDARY ENROLLME N T OPTIONS P ROGRAM
ED-01763-17
NOTICE OF STUD E N T REGISTRATION
2016-17
NOTE: Complete an enrollment form for each instructional term and postsecondary institution the student attends. Once Sections 1, 2,
and 3 are completely filled out, mail the enrollment form to the postsecondary institution. Do not mail this form to MDE.
We will fill in your
college ID once
submitted to us.
College Student ID Number: ________________________________
Be sure to write
your birth date, not
today’s date!
1. TO BE COMPLETED AND SIGNED BY THE STUDENT & PARENT/GUARDIAN
Student Name (Last, First, M.I.)
Even if you are
looking into doing
PSEO at more than
one institution,
put University of
Northwestern. When
you fill out another
state form for the
other institution,
you would put their
name in then.
Select Gender
M
F
Date of Birth (MM/DD/YYYY)
___________________________________________________________________________________________________________
Street Address:
City:
Zip Code:
Telephone Number:
___________________________________________________________________________________________________________
Postsecondary Institution This Term:
Parent/Guardian Name:
Address (if different than above)
___________________________________________________________________________________________________________
Minnesota Statutes, section 124D.09, subd. 6,requires students and parent/guardian sign a statement indicating they have received
information about the program, are aware counseling services are available and understand the responsibilities regarding enrollment in
postsecondary courses. We have received the information required under Minnesota Statutes, section 124D.09, and are aware the
student above is enrolling in postsecondary courses.
___________________________________________________________________________________________________________
Student Signature
Parent/Guardian Signature (if student is under 18)
Date
Upon completion of Section 1, pass this form to the pupil’s secondary school for completion of Section 2
2. TO BE COMPLETED BY SECONDARY/NON-PUBLIC/HOME SCHOOL
Make sure to sign!
Must be hand-written.
Electronic signatures
not accepted.
Parent signature is not
required if student is
18 or older
University of
Northwestern only
offers PSEO to high
school juniors and
seniors. The only
institutions to offer
earlier are a few
public institutions
with limited offering.
Secondary/Non-Public/Home School Name
School Type – Select One
Public or Non-Public or Home School
Only applicable
for Public School
students.
Student’s MARSS Number
___________________________________________________________________________________________________________
Attending School District Name
Attending School District #
Resident District Name
Resident District #
___________________________________________________________________________________________________________
Student’s grade while attending this Postsecondary Institution Grade 9
Grade 10
Grade 11
Grade 12
Select grade level
Public only
Public only
NOTE: HIGH SCHOOL GRADUATES AND 21 YEAR OLDS ARE NOT ELIGIBLE
___________________________________________________________________________________________________________
Students may not enroll in PSEO courses in addition to a full high school class load. Does this student have at least one free class
period during the high school day? (select one)
Yes
No
Is the above student eligible for program application? (See page 3 for requirements) (select one)
Yes
No
SECONDARY/NON-PUBLIC/HOME SCHOOL VERIFICATION
I certify the student identified in Section 1 meets the eligibility requirements outlined in Minnesota Statutes, section. 124D.09, to apply
for participation in the Postsecondary Enrollment Options (PSEO) program this term, and the information in Section 2 is accurate and
applicable to the student.
Secondary School Contact Name
Contact Signature
Email Address
Telephone
Date
___________________________________________________________________________________________________________
Directions: Upon completion of Section 2, pass this form to the postsecondary institution for completion of Section 3.
Again, make sure school signs!
Must be physical signature. Electronic signatures
not accepted.
Home School
students only need
to provide their
residential district
name and number;
Public and Private
School students only
need to provide their
attending school
district name and
number.
Make sure to answer
each question!
PSEO State Form Tips
Once completed, you can scan/e-mail to us at [email protected] or fax to 651-631-5680.
POSTSECONDARY ENROLLMENT OPTIONS NOTICE OF STUDENT REGISTRATION ED-01763-17
Student Name (Last, First, M.I.)
We fill out this
portion, so don’t
worry about it!
Date of Birth (MM/DD/YYYY)
PAGE 2
College Student ID Number
___________________________________________________________________________________________________________
3. TO BE COMPLETED BY THE POSTSECONDARY INSITUTION
Name of Postsecondary Institution
City of Postsecondary Institution
__________________________________________________________________________________________________________
_ Term of planned attendance
Semester 1
Semester 2
Qtr. 1
Qtr.2
Qtr.3
Select one
___________________________________________________________________________________________________________
Postsecondary Institution Contact Name
Email address
Telephone
___________________________________________________________________________________________________________
COURSES TAKEN FOR SECONDARY CREDIT
COURSE NUMBER
COURSE CREDITS
Course #1 _________________________________
_______________________
____________________
Course #2 _________________________________
_______________________
____________________
Course #3 _________________________________
_______________________
____________________
Course #4 _________________________________
_______________________
____________________
Course #5 _________________________________
_______________________
____________________
Course #6 _________________________________
_______________________
____________________
I certify the student identified in Section 1 is registered this term for the courses indicated above, all courses are non-sectarian in
content, are not remedial or developmental, and the student has indicated to me the courses are to be taken for secondary credit.
___________________________________________________________________________________________________________
Signature-Postsecondary Institution Contact Person
Title
Date
REQUIRED UNDER MINNESOTA STATUTE, SECTION 124D.09, SUBD. 5
“If an institution accepts a secondary pupil for enrollment under this section, the institution shall send written notice to the pupil, the
pupil’s school or school district, and the commissioner within ten days of acceptance. The notice must indicate the course and hours of
enrollment of that pupil.”
The postsecondary institution must mail a copy of this form, within ten days of acceptance, to the following address: Minnesota
Department of Education, Division of School Finance,1500 Highway 36 West, Roseville, MN, 55113.
Additionally, copies of the completed form must be sent, within ten days of acceptance, to the student indicated in Section 1 and the
secondary school of attendance indicated in Section 2.
PSEO State Form Tips
Once completed, you can scan/e-mail to us at [email protected] or fax to 651-631-5680.
POSTSECONDARY ENROLLMENT OPTIONS PROGRAM
STUDENT ELIGIBILITY - Minnesota Statutes, section 124D.68 and section
124D.09
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An 11 or 12 grade pupil enrolled in a Minnesota public, nonpublic, home school or American Indian-controlled
tribal contract or grant school eligible for aid under section 124D.83, except a foreign exchange pupil enrolled
in a district under a cultural exchange program, may apply to an eligible institution to enroll in nonsectarian
courses offered by that postsecondary institution.
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A 9 or 10 grade pupil enrolled in a district or an American Indian-controlled tribal contract or grant school eligible
for aid under section 124D.83, except a foreign exchange pupil enrolled in a district under a cultural exchange
program, may apply to enroll in nonsectarian courses offered under 124D.83, subd. 10, if
(1) The school district and the eligible postsecondary institution providing the course agree to the student’s
enrollment or
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(2) The course is a world language course currently available to 11 and 12 grade students, and consistent with
section 120B.022 governing world language standards, certificates, and seals.
Career and Technical Education (CTE) courses offered by a Minnesota state college or university
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th
th
A 10 , 11 , or 12 grade pupil enrolled in a district or an American Indian-controlled tribal contract or grant
school eligible for aid under section 124D.83, except a foreign exchange pupil enrolled in a district under a
cultural exchange program, may enroll in a career or technical education course offered by a Minnesota state
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college or university. A 10 grade pupil applying for enrollment in a career or technical education course must
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have received a passing score on the 8 grade Minnesota Comprehensive Assessment (MCA) in reading as a
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condition of enrollment. A current 10 grade pupil who did not take the 8 grade MCA in reading may
substitute another reading assessment accepted by the enrolling postsecondary institution
A.
Limit on Participation:
1) A pupil who first enrolls in grade 9 may not enroll in postsecondary courses for more than the
equivalent of four academic years.
2) A pupil who first enrolls in grade 10 may not enroll in postsecondary courses for more than the
equivalent of three academic years.
3) A pupil who first enrolls in grade 11 may not enroll in postsecondary courses for more than the
equivalent of two academic years.
4) A pupil who first enrolls in grade 12 may not enroll in postsecondary courses for more than the
equivalent of one academic year.
5) If a pupil in grade 9, 10, 11, or 12 first enrolls in a postsecondary course for secondary credit during
the school year, the time of participation shall be reduced proportionately.
B.
For purposes of determining PSEO eligibility:
1) An academic year is equivalent to a school year. A school year is defined as July 1 through June 30.
2) If a pupil is in a learning year or other year-round program and begins each grade in the summer
session, summer sessions shall not be counted against the time of participation.
3) If a district determines a pupil is not on track to graduate, the limit on participation does not apply to
that pupil
4) A pupil who has graduated from high school cannot participate in a program under this section.
5) A pupil who has completed course requirements for graduation but who has not received a diploma
may participate in the program.
C.
An institution shall not enroll secondary pupils, for postsecondary enrollment options purposes, in
sectarian, remedial, developmental, or other courses that are not college level unless the student is an
alternative education student participating in an approved full-time early/middle college program
designed with a well-defined pathway to allow the student to earn a certificate or degree.
D.
All textbooks and equipment provided to a pupil, and paid for under Minnesota Statute, section 124D.09,
Subdivision 13, are the property of the pupil’s postsecondary institution. Each pupil is required to return all
textbooks and equipment to the postsecondary institution after the course has ended.
For more information on the program and requirements, view the Postsecondary Enrollment Options School Finance
webpage at MDE > School Support > School Finance > Postsecondary Enrollment Options.